HomeMy WebLinkAbout1000-53.-5-12.6 OFFICE LOCATION: f S 0 MAILING ADDRESS:
Town Hall Annex P.O. Box 1179
54375 State Route 25 Southold, NY 11971
(cor. Main Rd. &Youngs Ave.)
Southold, NY 11971 Telephone: 631 765-1938
LOCAL WATERFRONT REVITALIZATION PROGRAM
TOWN OF SOUTHOLD
To: Leslie Kanes-Weisman, ZBA Chairperson
Members of the Zoning Board of Appeals
Cc: Julie McGivney, Assistant Town Attorney
From: Heather Lanza, AICP, Planning Director
LWRP Coordinator
Date: September 24, 2026
Re: LWRP Coastal Consistency Review
Charles Szarka — Breezy Shores Cottage #26, SCTM #1000-53.-5-12.6
ZBA File Ref. No. #8134
This application is a request for a variance from Article XXII Section §280-123. The
Building Inspector's March 4, 2026 Notice of Disapproval is based on an application to
construct additions and alterations to an existing seasonal cottage at 65490 Main Road
Greenport, NY (Breezy Shores Cottage #26).
The proposed action has been reviewed under Chapter §268, Waterfront Consistency
Review of the Town of Southold Town Code and the Local Waterfront Revitalization
Program (LWRP) Policy Standards.
Based upon the information provided on the LWRP Consistency Assessment Form
submitted to this department, as well as the records available to me, it is my
recommendation that the proposed action is EXEMPT with the policies of the LWRP as
follows:
Chapter§268-3 Definitions.-
MINOR ACTIONS BB. Additions to an existing dwelling constituting less than
25% of the existing structure where the addition is greater than 75 feet from a
natural protective feature, except where the parcel is located in a coastal erosion
hazard area
The LWRP Consistency Assessment Form states that the proposed action consists of
raising the seasonal cottage 3 ft. in elevation to comply with FEMA requirements and
adding 23 ft. to the building square footage through two dormers to create a storage loft.
The proposed action is exempt from LWRP review.
The proposed action has been reviewed under Chapter §268, Waterfront Consistency
Review of the Town of Southold Town Code and the Local Waterfront Revitalization
Program (LWRP) Policy Standards.
2
BOARD MEMBERS
Southold Town Hall
Leslie Kanes Weisman,Chairperson
hair 53095 Main Road - P.O.Box 1179
�� .
Patricia Acampora Southold,NY 11971-0959
Robert Lehnea,Jr. col Office Location:
Nicholas Planamento Town Annex/First Floor
Margaret Steinbu OUN
54375 Main Road(at Youngs Avenue)
gler �' �+�
�- Southold,NY 11971
http:1lsoutho ld townny.goes
ZONING BOARD OF APPEALS
TOWN OF SOUTHOLD
Tel.(631)765-l So9
�4 P, J 14
May 19, 2026 _�' � ._;
3 ;
Heather Lanza Town Planning Director MAY I !l /L,0��`Jf
LWRP Coordinator SO UTH0L.D'f�VVN
Board office P I A Nfi�I N��0�.��D
Planning
Town of Southold
Town Hall Annex
Southold, NY 11971
Re: ZBA File Ref. No. 8134 — Charles Szarka — Breezy Shores Gotta e #26
Dear Sir or Madam:
We have received
an application to construct additions and alterations to an existing seasonal cottage. A copy of
the Building Inspector's Notice of Disapproval under Chapter 280 (Zoning Code), and survey map, project
p pp
description form, are attached for your reference.
Your written
evaluation with recommendations for this proposal, as required under the Code procedures of LWRP
Section 268-5D is requested within 30 days of receipt of this letter.
Thank you.
Very truly yours,
Leslie K. Weisman
Chairpers 9 n
Z VI
By
Encl.
Site Plan/Survey-, Frank Uellehdahl, dated December 27, 2025
Public Hearing Date: October 1, 2026
FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD,N.Y. --_
NOTICE OF DISAPPROVAL
DATE: March 4, 2026
TO: Frank Uellendahl. (Szarka)
PO Box 316
Greenport,NY 11944
Please take notice that your application dated January 20, 2026:
For permit to: construct additions and alterations to an existin seasonal cotta e
Location of property: 65490 Main Road Green art NY reezy Shores Cottage#26
County Tax Map No. 1000 - Section 53 .Block 5 Lot 12.5
Is returned herewith and disapproved on the following grounds:
.,
The ro osed construction on this conforminglot in the R-80 District is not allowed
pursuant to Article 'XIII Section 280--123 which states; "A nan-conforming building
containing_a non-conforming use shall not be enlarged, reconstructedor structurally,
altered or moved exce t as set forth below: unless the use of such building is chap ed to
a conforming use."
Authorized 09nature
Note to Applicant: Any change or deviation to the above referenced application may
require further review by the Southold Town Building Department.
CC: file,Z.5.A*
APPLICATION TO THE SOUTHOLD TOWN BOARD OF APPEALS
AREA VARIANCE
House No. 9/0Street C Hamlet x
f w
e�,'Lb-
TM l000 Section: Block: Lots Lot Size: � Zone 7'
SC ( }
I (WE) APPE L TJIE WRITTEN DETERMINATION OF THE BUILDING INSPECTOR
DATED (,20 BASED ON SURVEY/SITE PLAN DATED /2
Owner(s): � S '�
Mailing Address: �5 Z� 4
Ls
f Fax: E m ail:L/? r 6 f>
Tele hone: ��. Fax.
P
NOTE: In addition to the above,please complete below if application is signed by applicant's attorney,agent,
architect, builder,contract vendee,etc.and name of person who agent represents:
Frank W, Uellendahl FAA
Name of Representative: 0P%%x04^-
far( Owner( } Other.
. .
Address
reenport, NY 11944
Telephone.
Fax. E mail. 44ak e
j LI)
Please check to specify who you fvisl correspondence to be mailed to,from the above names:
( ) Applicant/Owner(s), ( Authorized Representative, ( ) Other Name/Address below:
WHEREBY THE BUILDING INSPECTOR REVIEWED SURVEY/SITE PLAN
opol
DATED 12,, and DENIED AN APPLICATION DATED /,. ` FOR:
( Building Permit
( } Certificate of Occupancy ( }Pre-Certificate of Occupancy
( } Change of Use
( } Permit for As-Built Construction
( } Other:
Provision of the Zoning Ordinance Appealed. (Indicate Article,Section,Subsection of Zoning Ordinance
by numbers. Do not quote the code.)
Article: Section: , 0 Subsection:
Type of Appeal. An Appeal is made for:
(vorA Variance to the Zoning Code or Zoning Map.
( } A Variance due to lack of access required by New York Town Law-Section 280r-A.
( } Interpretation of the Town Code,Article Section
( } Request for Reversal or Overturn the Zoning Officer's Denial
Other
A prior appeal( has, ( } has not been made at any time with respect to this property,
UNDER Appeal No(s). Year(s). .
(Please be sure to research before completing this question oi-call our off ce.1br assistance)
2,�V! 0
4Z472L..
66 2.0 t2AVI- 6�1210iiel
• c '
= � Z
PART A: REASONS FOR APPEAL
(1) An undesirable change will not be produced in the CHARACTER of the neighborhood
or a detriment to nearby properties, if granted, because:
It has been determined by the Town of Southold that all 28 seasonal cottages at Breezy Shores
Community, Inc. constitute non-conforming buildings containing a non-conforming residential use.
Therefore the Building Department has determined-that relief is required to undertake the proposed
renovations and alterations because the structure will not be changed to a conforming use. This
unique property represents its own neighborhood of 82.6 acres with substantial wetlands and it's far
removed from neighboring properties so that no adjacent property owner will be adversely impacted
by the proposed structural improvements. The addition will increase the size of the existing structure
minimally by less than 3%.
(2) The benefit sought by the applicant CANNOT be achieved by some method feasible
for the applicant to pursue, other than an area variance, because:
Due to the pre-existing, non-conforming residential use of the cottage that cannot be enlarged and
structurally changed, it is not possible to make the proposed improvements to the cottage without
the requested relief from the code.
(3) The amount of relief requested is not substantial because:
The footprint expansion of the cottage is only 13 SF. In prior decisions related to other Breezy
Shores applications involving proposed footprint enlargements of less than 3% the Board has
deemed such increases to be de minimus in nature.
(4) The variance will NOT have an adverse effect or impact on the physical or
environmental conditions to the neighborhood or district because:
Due to the isolated location of the property a variance relief in this community will not produce a
negative impact on the physical or environmental conditions.
(b) Has the alleged difficulty been self-created? (X) Yes, or No. why?
Yes, because the applicant bought the cottage after the Zoning Code was in effect and was aware
about the limitations regarding alterations to the structure, however, the need for a variance is not
self-created because a seasonal dwelling requires periodically some degree of reconstruction or
alteration to continue the safe use of the structure.
Are there any Covenants or Restrictions concerning this land? (X) No Yes
This is the MINIMUM that is necessary and adequate, and at the sme time preserve and protect
the character of the neighborhood and the health, safety and welfare of the community
By signing this document, the PROPERTY OWNER understands that pursuant to Chapter 280-
148(B) of the Code of the Town of Southold, any variance granted by the Board of Appeals
shall become null and void where a Certificate of occupancy has not been procured, and/or
subdivision neap has not been filed with the Suffolk County Clerk, within three (3) years from the
date such variance was granted, The Board may, upon written request prior of the date of
expiration, grant an extension not to exceed three (3) consecutive one (1) year terms. IT IS
THE PROPERTY OWNER'S RESPONSIBILITY TO ENSURE COMPLIANCE WITH THE CODE
REQUIRED TIME FRAMEDESCRIBE❑ HEREIN.
--
Sworn to before me this .....a.a=a.a.rra Day
of May .arra.rw, �NIE D.BUNCH
Notary Public,State of New York i }
No.oI BU6185050 �
Oualified in Suffolk County
Commission Expires April 14,2 ..,,.. ...;.r.s .�a....a.Egg aa.s..Ka.a.raa.MGM..aaa.FEW..asa.■a.aa.e..awasaa.r.
r..rassasr.ar.s . sr.aafa
Notary Public: Signat a of Appll ant or Authoraized Agent
3
Zoning Board of Appeals
APPLICANT'S PROJECT DESCRIPTION
APPLICANT. RRA,
SCTM No. 100( 12 J 45;>
1. For Demolition of Existing Building Areas
Please describe areas being removed: f5nH&
4�� LAI
II. New Construction Areas (New Dwelling or New Additions/Extensions):
Dimensions of first floor extension: �s .
Dimensions of new second floor:
Dimensions of floor above second level:
Height(from existing natural grade):Is basement or lowest floor area being constructed`? If yes, please provide height (above ground) measured from
natural existing grade to first floor:
4"4�1
VZAIAU66
III.Proposed Construction Description (Alterations or Structural Changes)
(Attach extra sheet if necessary). Please describe building areas:
Number of Floors and General Characteristics BEFORE Alterations:
Ire
Number of Floors and Changes WITH Alterations:
7a
IV. Calculations of building areas and lot coverage,sky plane (From Surveyor, Design Professional):
Existing square footage of buildings on your property:
Proposed increase of building coverage:
Square footage of your lot: `r ' �
Percentage of coverage of your lot by building area(lot coverage) ,
Grass Floor Area GF of single family dwelling including the attached garage and/or habitable detached
accessory structure: (Please refer to Chapter 280, Section 280-207 of the Town Code):
For Residential lots, is project within the allowable Sky Plane? (Please refer to Chapter 280, Section 280-208 of
the Town Code):
V. Purpose of New Construction: 1 PX2,C--,1L C- i,IA.f6�- 44�5-i�" +
2 OAS
VI. Please describe the land contours (flat,slope %, heavily wooded, marsh area, etc.) on your land and
how it relates to the difficulty in meeting the code requirement(s): Describe on separate page if needed:
�Q i5=- T(Lie ' /0 � � Ai2t5-A /UEA R&Y4-1Wb
a - A1'00U t242im"me
Please submit 8 sets of photos, labeled to show different angles of yard areas after staking corners for
new construction, and photos of building area to be altered with yard view.
Revised 6/2023
QUESTIONNAIRE
FOR. FILING- WITH YOUR ZBA APPLICATION
A. Is the subject premis currently listed on the real estate market for sale?
Yes No
B. Are t ere any proposals to change or alter land contours?
No Yes, please explain on separate sheet.
C. 1.) Are there areas that contain sand or wetland grasses? 1.
2. Are those areas shown on the survey submitted with this application? Vi
3.) Is the property bulk headed between the wetlands area and the upland building area?
4.) If your property contains wetlands or pond areas, have you contacted the office of the
BOARD OF TRUSTEES for its determination of j urisdiction?
Please confirm status of your inquiry or application with the Board of Trustees:
If issued, please attach copies of your permit listing conditions of approval with a copy of
the approved survey.
D. Is there a depression or sloping elevation near the area of proposed construction at or
below five feet above mean sea level? AAAWE
C .,
E. Are there any patios, concrete barriers, bulkheads or fences that exist that are not shown
on the survey that you are submitting?
If any of the aforementioned items exist on your property, please show them on a site
plan.
F. Are there any construction projects currently in process on your property?
If yes, please submit a copy of yoLir building permit and survey as approved by the Building
Department and please describe scope of work:
G. Please attach all pre-certificates of occupancy and certificates of occupancy for the subject
premises. If none exist, please apply to the Building Department to obtain them or to obtain an
Amended Notice of Disapproval.
H. Do You or any co-owner also own other land adjoining or close to this parcel? 0
If yes, please label the proximity of your lands on your survey and identify'the Suffolk
County Tax Map No.
I. Please list present use or operations conducted at your property, and/or the proposed use
(examples, existing single family, proposed:same with brage,pool or other)
r
� r
f
Date
Authoriz si Li e
U
AGRICULTURAL DATA STATEMENT
ZONING BOARD OF APPEALS
TOWN OF SOUTHOLD
WHEN To USE THIS FORM: This form must he completed by the applicant for any special use
permit, site plan approval, use variance, area variance or subdivision approval on property within
an agricultural district OR within 500 feet of a farm operation located in an agricultural district.
All applications requiring an agricultural data statement must be referred to the Suffolk County
Department of planning in accordance with Section 239m and 239n of the General.Municipal
Law.
1. Name of Applicant: F -�
2. Address of Applicant: A l4y � �.EAJ RCICU2-,lutl- �
3. Name of Land Owner(if other than Applicant):� 40--&-
4. Address of Land owner: �W' //�2 9-2
&4h()
5. Description of Proposed Project: 41/= "' = `� �
�
/0
�& 7 1
6. Location of Property: (Road and Tax map Number)
12,e��
F r
7. Is the parcel within 500 feet of a farm operation? X Yes J No
8. Is this parcel actively farmed? � JYes f � No
9. Name and addresses of any owner(s) of land within the agricultural district containing active
farm operations. SLIffolk County Tax Lot numbers will be provided to you by the Zoning Board
Staff, it is your responsibility to obtain the current names and mailing addresses from the Town
Assessor's office (765-193 7) or from the Real Property Tax Office located in Riverhead.
NAME and ADDRESS
Z�.
1.
cliz
4.
5.
6.
e the b c f i s age if there are additional property owners)
(Pleas u page p p Y
6
1 � i
1 1
2 t��
SignatQ of Applicant Date
Note:
1. The local Board will solicit comments from the owners of land identified above in order to consider the
effect of the proposed action on their farm operation. Solicitations will be made by supplying a copy of
this statement.
2. Comments returned to the local Board will be taken into consideration as part as the overall review of
this application.
3. Copies of the completed Agricultural Data Statement shall be sent by applicant to the property owners
identified above. The cost for mailing shall be paid by the Applicant at the time the application is
submitted for review.
Page 9—Use Variance Application, Revision Nov.2023
Board of Zoning Appeals Application
OWNER'S AUTHORIZATION
(Where the Applicant is not the Owner)
I ' Ycresiding at
(Print property owner's name (Mailing Address)
do hereby authorize
(Agent)
to apply for variance(s) on my behalf from the
Southold Zoning Board of Appeals.
By signing this document,the Property Owner understands that pursuant to Chapter 280-
146(B) of the Code of the Town of Southold any variance granted by the Board of Appeals shall
become null and void where a Certificate of Occupancy has not been procured, and/or a
subdivision map has not been filed with the Suffolk County Clerk,within three(3)years from
the date such variance was granted. The Board of Appeals may, upon written request prior to
the date of expiration, grant an extension not to exceed three(3) consecutive one(1) year terms.
IT IS THE PROPERTY OWNER'S RESPONSIBILITY TO ENSURE COMPLIANCE WITH
THE CODE REQUIRED TIME FRAME DESCRIBED HEREIN.
(Owner's Signature) (Dated)
6w4la6p,T h/ JI ,zfilclr4i
(Print Owner's Name)
Revised 12/30/2025
APPLICANVOWNER
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics rohibits conflicts of interest on the art of town off cers and em to ees,The purpose of
this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is
necessary to avoid same.
YOUR NAME .
(Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a
company.If so,indicate the other person's or company's name.)
TYPE of APPLICATION: (Check all that apply)
Tax grievance Building Permit
Variance Trustee Permit
Change of Zone Coastal Erosion
Approval of Plat Mooring
Other(activity) Planning
Do you personally(or through your company,spouse,sibling, parent,or child) have a relationship with any officer
or employee of the Town of Southold?"Relationship" includes by blood, marriage,or business interest. "Business
interest" means a business, including a partnership, in which the town officer or employee has even a partial
ownership of(or employment by) a corporation in which the town officer or employee owns more than 5% of the
shares.
YES NO
If you answered "YES",complete the balance of this form and date and sign where indicated.
Name of person employed by the Town of Southold
Title or position of that person
Describe the relationship between yourself(the applicant/agent/representative) and the town officer or employee.
Either check the appropriate line A) through D)and/or describe in the space provided.
The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply) :
A)the owner of greater that 5% of the shares of the corporate stock of the applicant(when the applicant is a
corporation)
B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation)
Q an officer,director, partner,or employee of the applicant; or
D)the actual applicant
DESCRIPTION of RELATIONSHIP
y
Submitted this day of 1141A 20947
Signature
Print Name .
AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town ofSouthold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of
this form is to rovide information which can alert the town of possible conflicts of interest and allow it to take whatever action is
necessary to avoid same.
YOUR NAME :
(Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a
company.if so,indicate the other person's or company's name.)
TYPE OF APPLICATION: (Check all that apply)
Tax grievance Building Permit
Variance Trustee Permit
Change of Zone Coastal Erosion
Approval of Plat Mooring
Other(activity) Planning
Do you personally (or through your company,spouse,sibling, parent,or child) have a relationship with any officer
or employee of the Town of Southold?"Relationship" includes by blood, marriage, or business interest. "Business
interest" means a business, including a partnership, in which the town officer or employee has even a partial
ownership of(or employment by)a corporation in hich the town officer or employee owns more than 5% of the
shares.
YES NO
If you answered"YES", complete the balance of this form and date and sign where indicated.
Name of person employed by the Town of Southold
Title or position of that person
Describe the relationship between yourself(the applicant/agent/representative) and the town officer or employee.
Either check the appropriate line A) through D)and/or describe in the space provided.
The town officer or employee or his or her spouse,sibling, parent,or child is(check all.that apply)
A)the owner of greater that 5%of the shares of the corporate stock of the applicant(when the applicant is a
corporation)
B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation)
Q an officer,director,partner,or employee of the applicant; or
D)the actual applicant
DESCRIPTION OF RELATIONSHIP
Submitted this day of
HeqI420
4111
Signature
Print Name
617.20
Appendix B
Short Environmental Assessment Form
Instructions for Completing
Part 1 -Project information. The applicant or project sponsor is responsible for the completion of Part 1. Responses
become part of the application for approval or funding,are subject to public review,and may be subject to further verification.
Complete Part I based on information currently available. If additional research or investigation would be needed to fully
respond to any item,please answer as thoroughly as possible based on current information.
Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful
to the lead agency;attach additional pages as necessary to supplement any item.
Part I -Project and Sponsor information
Name of Action or Project:
,4!5ZAR A<'A
Project Location(describe,and attach a location map):
z��'06�400
Brief Description of Proposed Action:
�ii�:-OL z 1ple� f
•2f i
� Y 1
Name of Applicant or Sponsor: Telephone: ,� r
E-MailRank fellench2hl M A : 1 �-�� W*zzol
Address: ROO BOX 316
City/PO: State: Zip Code:
1. Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, No YES
administrative rule,or regulation?
If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that
may be affected in the municipality and proceed to Part 2. If no,continue to question 2.
2. Does the proposed action require a permit,approval or funding from any other governmental Agency? No YES
If Yes,list agency(s)name and permit or approval:
f
3.a.Total acreage of the site of the proposed action? _ .; acres
b.Total acreage to be physically disturbed? 0 acres
c.Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? 8:2.04-7--acres
4. Check all land uses theurall
cur on,adjoining and near the proposed ion.
❑Urban (non-agriculture) ❑industrial Commercial /esidential(suburban)
❑Forest riculture aquatic ❑Dther(s ecify):
g p
❑Parkland
Page 1 of 4
5. Is the proposed action, NO YES NIA
a.A permitted use under the zoning regulations? r
b.Consistent with the adopted comprehensive plan?
6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES
landscape? V
7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES
If Yes, identify:
8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES
a V
b.Are public transportation service(s)available at or near the site of the proposed action?
c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action?
9.Does the proposed action meet or exceed the state energy code requirements? NO YES
If the proposed action will exceed requirements,describe design features and technologies: V/
10. Will the proposed action connect to an existing public/private water supply? NO YES
If No,describe method for providing potable water:
11. Will the proposed action connect to existing wastewater utilities? NO YES
If No,describe method for providing wastewater treatment:
12. a. Does the site contain a structure that is listed on either the State or National Register of Historic NO YES
Places? 17
b. Is the proposed action located in an archeological sensitive area?
13. a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES
wetlands or other waterbodies regulated by a federal,state or local agency?
b. Would the proposed action physically alter,or encroach into,any existing wetland or waterbody?
If Yes, identify the wetland or waterbody and extent of alterations in square feet or acres:
14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply:
❑ Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional
❑ Wetland ❑Urban ❑Suburban
15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES
by the State or Federal government as threatened or endangered? V1
16.Is the project site located in the 100 year flood plain? NO YES
17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES
If Yes,
a.W i I I storm water discharges flow to adjacent properties? VNO❑YES
b.Will storm water discharges be directed to established conveyance systems(runoff and orm drains)? J rt': r °y
If Yes,briefly describe: ❑NO VYES
Page 2 of 4
1 S.Does the proposed action include construction or other activities that result in the impoundment of NO YES
water or other liquids(e.g.retention pond,waste lagoon,dam)?
1f Yes,explain purpose and size:
19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES
solid waste management facility?
If Yes,describe:
20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES
completed)for hazardous waste?
If Yes,describe: ;
1
I AFFIRM TME ,
THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLED _
do,
Applicantlspdns `t� � -� � ��.,� Date: 4,u ar,>
! r
Signature:
Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2, Answer all of the following
questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or
otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my
responses been reasonable considering the scale and context of the proposed action?"
No,or Moderate
small to large
impact impact
may may
occur occur
1. Will the proposed action create a material conflict with an adopted land use plan or zoning
regulations?
2. Will the proposed action result in a change in the use or intensity of use of land?
3. Will the proposed action impair the character or quality of the existing community?
4. Will the proposed action have an impact on the environmental characteristics that caused the
establishment of a Critical Environmental Area(CEA)?
5. Will the proposed action result in an adverse change in the existing level of traffic or
affect existing infrastructure for mass transit,biking or walkway?
6. will the proposed action cause an increase in the use of energy and it fails to incorporate
reasonably available energy conservation or renewable energy opportunities?
7. will the proposed action impact existing:
a.public 1 private water supplies?
b.public I private wastewater treatment utilities?
S. will the proposed action impair the character or quality of important historic,archaeological,
architectural or aesthetic resources?
9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands,
waterbodies,groundwater,air quality,flora and faunae
Page 3 of 4
No,or Moderate
small to large
impact impact
may may
occur occur
to. Will the proposed action result in an increase in the potential for erosion,flooding or drainage
problems?
11. Will the proposed action create a hazard to environmental resources or human health?
Part 3- Determination of significance. The]Lead Agency is responsible for the completion of Part 3. For every
question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular
element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3.
Part 3 should,in sufficient detail,identify the impact, including any measures or design elements that have been included by
the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact
may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring,
duration, irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and
cumulative impacts.
❑ Check this box if you have determined,based on the information and analysis above,and any supporting documentation,
that the proposed action may result in one or more potentially large or significant adverse impacts and an
environmental impact statement is required.
❑ Check this box if you have determined,based on the information and analysis above,and any supporting documentation,
that the proposed action will not result in any significant adverse environmental impacts.
Name of Lead Agency Date
Print or Type Name of Responsible Officer in Lead Agency Title of Responsible officer
Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer)
Page 4 of 4
Town of Southold
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
I. All applicants for permits* including Town of Southold agencies, shall -complete this CCAF for
proposed actions that are subject to the Town of Southold waterfront Consistency Review Law. This
assessment is intended to supplement other information used by a Town of Southold agency in
making a determination of consistency. *Except minor exempt actions including Building Permits
and other ministerial permits not located within the Coastal Erosion Hazard Area.
Z. Before answering the questions in Section C, the preparer of this form should review the exempt
minor action list, policies and explanations of each policy contained in the Town of Southold Local
Waterfront Revitalization Program. A proposed action will be evaluated, as to its significant
beneficial and adverse effects upon the coastal area(which includes all of Southold Town).
3. If any question in Section C on this form is answered "yes", then the proposed action may affect the
achievement of the LWRP policy standards and conditions contained in the consistency review law.
Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a
determination that it is consistent to the maximum extent practicable with the LWRP policy
standards and conditions. If an action cannot be certified as consistent with the LVW policy
-standards and conditions, it shall not be undertaken.
A copy of the LWRP is available.in the following places: online at the Town of Southold
website (southoldtown.northfork.net), the Board of Trustees office, the Planning Department, all
local libraries and the Town Clerk's office.-
B. DESCRI[PTION OF SITE AND PROPOSED ACTION
SCTM#
The Application has been submitted to (check appropriate response):
� Tr
ustees
'own Board Planning Dept. M/Building Dept. Board of Tru
1. Category of.Town of Southold agency action (check appropriate response):
(a) Action undertaken directly by Tov�n agency(e.g. capital
construction, planning activity, agency regulation, land transaction)
(b) Financial assistance(e.g. grant, loan, subsidy)
.(c) Permit, approval, license, certification:
Nature and extent of action:
Location of action: ;Qdt.1FE 2-G ',
Site acreage:
Present land use:
Present zoning classification: ,& — �
2. If an application for the proposed action has been filed with the Town of Southold agency, the following
information shall be provided:
(a) Name of applicant:
(b) Mailing address: � ����'TG:T, G�!�' ��J-k1J� �
ZsA&I, 4�194<�
(c) Telephone number: Area Code
(d) Application number, if any:
Will the action be directly undertaken, require funding,or approval by a state or federal agency?
Yes No❑ If yes, which state or federal agency?
DEVELOPED COAST POLICY
Policy 1. Foster a pattern of development in the Town of Southold #hat enhances community character,
preserves open space,makes efficient use of infrastructure, makes beneficial use of a coastal location, and
minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation
criteria.
EJ Yes No Z(Not.Applicable - please explain)
'FRO Py`1St7-J::) 7
X�ltz
V,te-k L a--� �a oo L2 TLai t%J
Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See
LWRP Section III—Polic' s Pages 3 through 6 for evaluation criteria
0 Yes � No (Not Applicable—please explain) ,
2�� u��-r���.�� coTt��s Q_3�mac- ��v�� (:_�4pv7r (99L)Oej e, &_
rK)VAL(--* `1ltE COf OV� Aa(5 G_F' (tt67 C32L__�Ezy S402�S
Attach additional sheets if necessary
Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See
LYMP Section III--Policios,Pages 6 through 7 for evaluation criteria
Yes No (Not Applicable--please explain)
Attach additional sheets if necessary
NATURAL COAST POLICIES
Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See L'VVW
Section III—Policies Page 8 through 16 for evaluation criteria
Yes No (Not Applicable please explain)
LO AVVto.
Attach additional sheeta if necessary
Policy S. Protect and impr e water quality and supply in the Town of Southold.. See LWRP Sect-ion III
Policies Pages 16 throua 21 for evaluation criteria
0
Yes No (Not Applicable please explain)
Attach additional sheets if necessary
Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including
Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22
through 32 for evaluatio criteria.
E Yes No (Not Applicable-- please explain)
Attach additional sheets if necessary
Policy 7. Protect and improve air quality in the Town of Southold. See LV RP Section III — Policies
Pages 32 through 34 for evaluation criteria. See Section III—Policies Pages; 34 through 38 for evaluation
criteria.
Yes No (Not Applicable--please explain)
Attach additional sheets if necessary
Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous
substances and wastes See LW-RP Section III-�--Policies; Pages 34 through 38 for evaluation criteria.
Yes No [Nat Applicable-- please explain)
PUBLIC -COAST POLICIES
Policy 9. Provide ,for public access to, and recreational use of, coastal waters, public lands, and public
resources of the Town of duthold. See LwRP Section III—Policies; Pages 38 through 46 for evaluation
criteria.
Ye No (Not Applicable--- please explain)
Attach additional sheets if necessary
WORKING COAST POLICIES
Policy 10. Protect South. Id's water-dependent uses and promote siting of new water--dependent uses in
suitable locations. Se wRP Section III- Policies; Pages 47 through 56 for evaluation criteria.
Yes No (Not Applicable--please explain)
Attach additional sheets if necessary
Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic
Estuary and Town wa ears. See LwRP Section III-Policies; Pages 57 through 62 for evaluation criteria.
Yes No Not Applicable-please explain
Attach additional sheets if necessary
Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III -- Policies; Pages
62 through 65 for.evatNot
on criteria.
0 ❑ -
Yes No Applicable please explain
Attach additional sheets if necessary
Policy 13. Promote appropriate use and development of energy and mineral resources. See LVVRP
Section III-Policies; ages 65 through 68 for evaluation criteria.
Yes No Not Applicable-please explain
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23442 5 15 96 PERMIT REPAIR COTTAGE #25
23443 5 15 9 PERMIT REPAIR. CTG #12
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2
3 444 5 15 96 PERMIT REPAIR COTTAGE #4 Woodland
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House PlotBULKHEAD
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_7
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Extension --- -- ��
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26 BREEZY SHORES
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PROPOSED EAST ELEVATION PROPOSED NORTH ELEVATION � LEMONS
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